Provider Demographics
NPI:1477626166
Name:HANZELIN, RAYMOND HENRY (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:HENRY
Last Name:HANZELIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 81ST ST
Mailing Address - Street 2:1D
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5948
Mailing Address - Country:US
Mailing Address - Phone:708-227-3338
Mailing Address - Fax:
Practice Address - Street 1:7851 OGDEN AVE
Practice Address - Street 2:1D
Practice Address - City:LYONS
Practice Address - State:IL
Practice Address - Zip Code:60534-1320
Practice Address - Country:US
Practice Address - Phone:708-442-4901
Practice Address - Fax:708-442-4904
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL162862213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT36944Medicare UPIN
IL521770Medicare PIN